Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Patient 005

58y·female·white·ASCVD 3.1%

2 active reversal flags

  1. EndocrinologyHigh

    Hormone therapy for chronic disease prevention

    Why flagged

    Systemic HRT in an asymptomatic menopausal patient; chronic disease prevention use reversed by WHI 2002 and USPSTF 2022 (Grade D).

    1. Prior guidance2002

      Estrogen or combined estrogen/progestin hormone therapy widely prescribed for cardioprotection and chronic disease prevention (Pre-2002 consensus).

    2. WHI2002

      Combined CEE+MPA increased CHD (HR 1.18), stroke (HR 1.31), and invasive breast cancer (HR 1.26; 95% CI 1.00-1.59). Estrogen alone increased stroke risk without CHD benefit.

    3. Reversal2022

      Guidelines updated

    4. Current recommendation

      USPSTF (2022): Grade D recommendation against the use of systemic combined estrogen/progestin or estrogen alone for the primary prevention of chronic conditions.

  2. Perioperative MedicineHigh

    Perioperative beta-blockers for noncardiac surgery

    Why flagged

    Beta-blocker-naive patient scheduled for noncardiac surgery; acute initiation reversed by POISE 2008 (doubled stroke risk HR 2.17, increased all-cause mortality).

    1. Prior guidance2008

      Routine, acute initiation of beta-blockers immediately prior to noncardiac surgery in patients at risk for cardiovascular events to prevent perioperative MI.

    2. POISE2008

      Metoprolol reduced MI but doubled stroke risk (HR 2.17; 95% CI 1.26-3.74) and increased all-cause mortality (HR 1.33; 95% CI 1.03-1.74) due to hypotension and bradycardia.

    3. Reversal2014

      Guidelines updated

    4. Current recommendation

      2014 ACC/AHA Guidelines: Routine acute initiation of beta-blockers on the day of surgery in beta-blocker-naive patients is strictly not recommended.